The volume of unilaterally undescended testis after hCG therapy compared to orchidopexy and combined methods.

The aim of the study was to compare the effects of human chorionic gonadotropin (hCG) therapy with those of surgical or combined therapy on testicular volume (TV) in boys at different ages with unilateral canalicular undescended testis (UDT). In total, 155 boys aged 1 to 12 years were treated: either surgically (ST), or by 50 IU/kg body weight hCG administration every three days for five weeks (HT), or by a combination of the two. The patients underwent ultrasound examination of TV before the treatment, 9-12 (median 10) and 24-39 months (median 32) after therapy. The testicular atrophy index (TAI) of the affected testicle was calculated. The success rate was 94.7% for ST, 39.2% for HT and 98% for HST patients. The atrophy rate was 5.3% for ST, 0% for HT and 2% for HST. Neither treatment type nor patient age significantly influenced gonadal atrophy. No significant differences in TV of the affected testis were observed after treatment between the groups. The TAI values were significantly the lowest in HT group (p = 0.0006). Both TV and TAI changes from the baseline values did not differ between the treatment groups. At the 24- to 39-month follow-up, no significant differences were observed in the change in baseline TV and baseline TAI between age groups. TV of the affected testis increased significantly (p = 0.0000), and TAI decreased significantly over time (p = 0.01), with no significant differences depending on the age group, treatment type or the interaction of the two factors. The hCG therapy did not impair the development of affected and healthy testes, neither as single nor as neoadjuvant therapy, both during early assessment and after 2-3 years. Patients' age at the initiation of treatment seems irrelevant.

SU-E-T-575: To Analyze the Clinical Impact of Esophageal Sparing on Treatment Plans for Patients with Grade 3 Esophagitis.

PURPOSE: To analyze the clinical impact of esophageal sparing on treatment plans for patients with grade 3 esophagitis. METHODS: The treatment plans of 8 patients (project total: 20 patients) who were treated with IMRT and exhibited stage 3 esophagitis were re-planned to give a simulated clinical plan with dose distribution that mirrored our current clinical practice (74Gy to the target, and 5mm margins), and a plan that emphasized esophageal sparing. Doses to the esophagus, heart, cord, lung and PTV were compared. RESULTS: Comparing the esophageal sparing plan to the simulated clinical plan, the mean reduction in esophageal volume receiving 50, 55, 60, 65, and 70Gy were 2.0, 3.2, 5.0, 7.2, and 10.9 cm3 , respectively. The mean reduction in the continuous length of esophagus receiving 50, 55, 60, 65, and 70Gy were 12, 24, 38, 40, and 47mm, respectively. The associated reduction in dose to 90% and 95% of the PTV was 2.2 and 3.8Gy, respectively. Of the 8 patients examined, 2 showed a significant decrease in PTV coverage (4.6Gy, 12.3Gy for 90% of PTV), 4 showed decreases under 1.1Gy, but 2 showed an increase of 1.4Gy and 0.5Gy for 90% PTV. Cord dose was maintained below 50Gy, and there was a slight increase in mean heart dose and mean lung dose of 2.4Gy, and 2.7Gy, respectively. Data will also be presented comparing these plans with the actual treated plans (for which the patients had grade 3 esophagitis) and plans that emphasize PTV coverage. CONCLUSIONS: Treatment planning to emphasize esophageal sparing can reduce the volume and continuous length of the esophagus which receives high doses. There is some associated modest reduction in PTV coverage. In summary, in many cases esophageal sparing can be accomplished for lung cancer cases while maintaining adequate PTV coverage, although there is variability between patients.

SU-E-T-558: Assessing the Effect of Inter-Fractional Motion in Esophageal Sparing Plans.

PURPOSE: To compare esophageal dose distributions in esophageal sparing IMRT plans with predicted dose distributions which include the effect of inter-fraction motion. METHODS: Seven lung cancer patients were used, each with a standard and an esophageal sparing plan (74Gy, 2Gy fractions). The average max dose to esophagus was 8351cGy and 7758cGy for the standard and sparing plans, respectively. The average length of esophagus for which the total circumference was treated above 60Gy (LETT60) was 9.4cm in the standard plans and 5.8cm in the sparing plans. In order to simulate inter-fractional motion, a three-dimensional rigid shift was applied to the calculated dose field. A simulated course of treatment consisted of a single systematic shift applied throughout the treatment as well a random shift for each of the 37 fractions. Both systematic and random shifts were generated from Gaussian distributions of 3mm and 5mm standard deviation. Each treatment course was simulated 1000 times to obtain an expected distribution of the delivered dose. RESULTS: Simulated treatment dose received by the esophagus was less than dose seen in the treatment plan. The average reduction in maximum esophageal dose for the standard plans was 234cGy and 386cGY for the 3mm and 5mm Gaussian distributions, respectively. The average reduction in LETT60 was 0.6cm and 1.7cm, for the 3mm and 5mm distributions respectively. For the esophageal sparing plans, the average reduction in maximum esophageal dose was 94cGy and 202cGy for 3mm and 5mm Gaussian distributions, respectively. The average change in LETT60 for the esophageal sparing plans was smaller, at 0.1cm (increase) and 0.6cm (reduction), for the 3mm and 5mm distributions, respectively. CONCLUSIONS: Interfraction motion consistently reduced the maximum doses to the esophagus for both standard and esophageal sparing plans.

Less advanced testicular dysgenesis is associated by a higher prevalence of germ cell neoplasia.

There is a theory that the more evident clinical signs of testicular dysgenesis, the more frequent the neoplastic lesions are. The aim of this study was to relate the incidence of testicular germ cell neoplastic lesions (overt germ cell tumours--GCT or testicular carcinoma in situ) to the intensity of testicular organogenesis disturbances (dysgenesis). Biopsies were taken from 154 testes of the following patients: 23 patients with GCT in the contralateral gonad (CGCT), 41 patients with undescended testes operated in childhood (UDT), 90 with azoo-/oligozoospermia (A/O) diagnosed because of infertility. Assessment of seminiferous epithelium, number of Leydig cells, areal fraction of intertubular space (IS), morphometric analysis of seminiferous tubules diameter and thickness of tubular wall were performed. Monoclonal antibodies against placental like alkaline phosphatase and cytokeratin 18 were applied. Germ cell neoplastic lesions were detected in 7.1% of testes and were associated with disturbed spermatogenesis. Among testes with disturbed spermatogenesis they were found the most frequently in CGCT (22.2% vs. 11.1% in UDT and 3.8% in A/O), where spermatogenesis had the highest score (5.7 +/- 3.8 points vs. 4.2 +/- 2.7 in UDT and 4.6 +/- 2.9 in A/O). In CGCT, signs of testicular dysgenesis were less advanced: the highest tubular diameter was 164.4 +/- 32.3 microm vs. 163.5 +/- 28.6 in UDT and 161.4 +/- 31.5 in A/O, the lowest thickness of tubular wall was 8.9 +/- 3.2 microm vs. 10.2 +/- 3.6 in UDT and 10.2 +/- 3.2 in A/O, lowest IS was 36.9 +/- 14.9% vs. 47.9 +/- 18.0 in UDT and 46.5 +/- 18.5 in A/O, and the lowest percentage of tubules with immature Sertoli cells was 0.1 +/- 0.4% vs. 4.9 +/- 7.0 in UDT and 5.2 +/- 9.7 in A/O. Results indicate that neoplastic lesions appear only in testes with disturbed spermatogenesis. Worse condition of spermatogenesis is associated by the presence of other dysgenetic features, but neoplastic lesions appear more frequently in testes with the less advanced features of testicular dysgenesis.

Invertography versus ultrasonography and distal colostography for the determination of bowel-skin distance in children with anorectal malformations.

PURPOSE: To evaluate the usefulness, reliability and sensitivity of invertography, perineal ultrasonography (US) and augmented-pressure distal colostography (APDC) in the diagnostic assessment of children with anorectal malformations (ARM). MATERIAL AND METHODS: Author retrospectively analysed the results of bowel-skin distance measured by means of three different imaging techniques in 39 children with ARM. The obtained results were verified by intraoperative measurements. RESULTS: Sensitivity of invertography performed in 22 patients was 27 % with a mean error of measurement of 0.84 cm, and the difference between measurements and real distance was statistically significant. Sensitivity of perineal US (22 children) was 86 % (mean error 0.12 cm) and of APDC (26 patients) was 100 % (0.05 cm) with no significant difference between measurements and intraoperative findings (p > 0.001). CONCLUSIONS: The study revealed a limited usefulness of invertography in the diagnostic evaluation of ARM. Perineal US was extremely useful in the newborn period and provided reliable information on which to base a decision for either preliminary colostomy or definitive operation. With a colostomy in place APDC, the most sensitive of the three methods, allowed for later precise definition of the defect and visualization of fistulas between bowel and urogenital tract.

The usefulness of testicular atrophy index in the assessment of undescended testicle--preliminary report.

PURPOSE: Cryptorchidism affects 2-8% of male newborns. There is a controversy regarding timing of surgery as well as indications for orchiopexy in boys with retractile testicle. The aim of this study was to evaluate the clinical usefulness of testicular atrophy index (TAI) as a criterion of qualifying patients with undescended testes for surgery as well as of monitoring the results of treatment. MATERIAL AND METHODS: In 1999-2000, 105 cryptorchid boys, aged 1 to 15 years (mean 4.8) underwent unilateral orchiopexy. Dimensions and volume of testes were measured by means of scrotal US and TAI was calculated before and 1 year after surgery. RESULTS: Pre- and postoperative scrotal US measurements were analyzed in 35 boys divided into five age dependent groups. The preoperative TAI values ranged from 27.1% to 52.8%. The biggest loss in volume of affected testis was found in boys aged 4 to 10 years (35.4% to 52.8%). The TAI values measured one year after orchiopexy were lower than preoperative ones. Significant difference in TAI values, ranging from 18.16% to 36.43% were observed in boys between 2 and 10 years (p < 0.001). In the youngest (0-2 yrs) and the oldest boys (> 10 yrs) the difference was not statistically significant. CONCLUSIONS: The testicular atrophy index (TAI) proved to be a valuable and objective tool for qualifying patients with undescended testes for surgery as well as for monitoring the results of treatment. Its value of 20% and more should be considered an indication for surgery in boys with retractile testes.

Recurrence of varicocele after high retroperitoneal repair: implications of intraoperative venography.

PURPOSE: We determined whether intraoperative venography results in a decreased recurrence rate after varicocele repair in adolescence. MATERIALS AND METHODS: We evaluated 177 male adolescents 14 to 19 years old who underwent varicocele repair via the high retroperitoneal approach with artery sparing and intraoperative venography. RESULTS: Overall the recurrence rate was 2.8% (5 of 177 cases) in the venography group and 11% in historical controls without venography. We identified left-to-right cross communicating vessels in 3 patients with recurrence. Intraoperatively venography revealed nonligated vessels in 21 patients (12%), resulting in revision and repair during the same procedure. CONCLUSIONS: Intraoperative venography seems to decrease the rate of recurrence. Left-to-right cross communicating vessels may be present in some adolescents with recurrence after varicocelectomy.

Prevention of water vapour adsorption by carbon molecular sieves in sampling humid gases.

The water uptake by the solid sorbents Carbosieve S-III, Carboxen 569, 1000 and 1001, all of which are used for sampling of volatile organic compounds from the atmosphere. was examined using a direct experimental approach. The content of retained water is affected both by the trap temperature and the initial water vapour concentration in the sampled gas. Two different adsorption mechanism are operative. At low relative humidities (RH) only active polar centres are involved. This adsorption is so weak that negative water interferences can easily be managed. Another mechanism, the micropore volume filling, involves substantial amounts of water, becomes operative once the threshold value for relative humidity (RHth) is surpassed. RHth is 45+/-3% for Carboxen 1000 decreasing to 35+/-3% for the three other sorbents studied. A novel but simple strategy was tested for water management: moderate heating of the trap during the sampling (a warm trap method). The temperature elevation required depends on the RHth characteristic for the specific sorbent, and RH and the temperature of the sampled gas. Usually the 5-15 degrees C elevation is sufficient; only under extreme RH conditions is an elevation of 20 degrees C necessary. The diagrams are given to determine this elevation. Since the sample RH is significantly decreased at an elevated temperature the negative effect of water uptake on the safe sampling volume is alleviated. Consequently the sampled gas volume can be as large as desired which decreases detection limits.

[The results of forearm fractures by percutaneous stabilization in children]. / Wyniki leczenia zlaman trzonów kosci przedramienia u dzieci metoda przezskórnej, sródszpikowej stabilizacji.

Between 1997 and 1999, 332 children (251 boys and 81 girls), aged 1 to 16, with fractures of the forearm bones were treated at the Department of Pediatric Surgery and Oncology in Lódz. In 38 patients (11.4%) percutaneous intramedullary Kirschner wiring of displaced fragments was performed. Proper reduction and good union of the fractured bones was achieved in all cases. Early evaluation performed at 6 months to 2 years after surgery revealed full joint mobility, preserved bone axis and no bone-length differences in comparison with the healthy forearm. Limitation of carpal joint mobility found in 4 cases (10.5%) was treated with prolonged (3 to 6 months) therapeutic rehabilitation. No patient in the analyzed series showed any symptoms of ostitis. The obtained results indicate that percutaneous intramedullary Kirschner wiring is a simple and effective way of treating chosen cases of forearm fractures in children.

[Management of early symptoms of acute septic hip in neonates and infants--conservative or surgical?]. / Postepowanie terapeutyczne we wczesnym okresie ostrego krwiopochodnego zapalenia stawu biodrowego u noworodków i niemowlat--leczenie zachowawcze czy operacyjne?

The paper presents 41 cases of acute hip sepsis in 36 patients, age ranging from 5 to 66 days. 32 cases were treated at the Institute of Polish Mother Hospital and 4 at the Pediatric Surgery Department of the Medical School of Lódz. In 40% of the cases multifocal infections were noted. Septic arthritis was diagnosed basing on clinical symptoms, lab tests, ultrasound screening, X-rays and immunoglobulin scyntigraphy. Patients were divided into three groups according to treatment: group 1 was administered antibiotics and immobilization was applied (16 patients--19 hips), group 2 had a biopsy, was administered antibiotics and immobilization (5 patients--6 hips), group 3 had an arthrotomy performed, wound drainage, casting was applied and antibiotics were administered (15 patients--16 hips). Immobilization was maintained by means of a cast or Koszla's harness. Patients were qualified for surgery basing on ultrasound investigation. After completion of various modes of treatment patients were followed at the outpatient clinic of the orthopedic department. A complete assessment was performed 3-6 years after the first symptoms appeared. A full clinical examination (ROM assessment), X-ray investigations were performed. Hip dysfunction was assessed basing on X-ray images according to the Ho Choi classification. Conservative treatment seems to be sufficient in early stages of septic arthritis, with only minor morphological pathologies visible on ultrasound examination. Early arthrotomy seems to be the method of choice in septic arthritis treatment. Aspiration of the hip may not be possible due to solid consistency of pus.

Incidence of anorectal malformations in Lódz province.

PURPOSE: It is difficult to obtain reliable figures on incidence of anorectal malformations (ARM) from literature. The aim of the present study was to reveal the real incidence of these defects in a given area. MATERIAL AND METHODS: Between 1992 and 1997, 86 children with ARM were treated at the departments of paediatric surgery in Lódz. Parents of 30 (34.9%) children treated within the analysed period lived in the Lódz province. The real incidence of ARM in this area was calculated and birth parameters of children with ARM were compared with corresponding parameters of newborns born alive in Lódz. RESULTS: The studied incidence ranged from 1 in 1446 to 1 in 3035 in consecutive years and the average was 1 in 2295. Mean duration of pregnancy in children with low type ARM was 39.4 weeks and in children with high type ARM--38.8 weeks. Mean birth body weight of children with low defects was 3030 g, and of neonates with high defects--3185 g. Apgar score was respectively 8.7 and 8.8. There was also no significant difference in examined parameters (p > 0.05) between ARM children and the population of born alive newborns of Lódz area (respectively 38.9; 3297; 8.9). CONCLUSIONS: Anorectal malformations are among the common congenital anomalies in children. In the analysed group of children with ARM duration of pregnancy, birth weight and Apgar score were similar to these observed in the whole population of newborns born alive in Lódz province.

Posterior sagittal abdominoperineal pull-through: a new approach to definitive treatment of Hirschsprung's disease--initial experience.

PURPOSE: Posterior sagittal abdominoperineal pull-through (PSAPP) was applied for the surgical treatment of Hirschsprung's disease (HD) to decrease the incidence or eliminate the complications related to the major pullthrough procedures. METHODS: Ten children with HD underwent the new surgical procedure, PSAPR The diagnosis of the disease was established under 1 year of age in 7 children and between 2 and 5 years of age in three instances. The length of resected aganglionic segment ranged from 6 to 20 cm (mean, 11.9 cm). The follow-up period was 18 months to 4 years (mean, 2.7 years). Postoperative clinical and manometric results were compared with children after Rehbein procedure and with controls. RESULTS: Postoperative complications were observed in patients operated on first: anastomotic stenosis in three children, enterocolitis in three, constipation in two, anastomotic leak (iatrogenic injury) in one, and dehiscence of colostomy anastomosis in two patients. Improved surgical technique allowed to eliminate the causes of complications, and the last five children of this group who underwent surgery have had an uneventful postoperative outcome. CONCLUSION: The posterior sagittal approach with the posterior anorectotomy provides an excellent exposure of the operative field, allowing to perform the lowest possible resection and subsequent anastomosis.

Repair versus observation in adolescent varicocele: a prospective study.

PURPOSE: We designed a randomized prospective study of male adolescents with moderate and severe varicoceles to determine whether prophylactic varicocele repair is beneficial. MATERIALS AND METHODS: We evaluated 2,100 boys (10 to 20 years old) for genitourinary abnormalities. From this population 2 groups of adolescents 15 to 19 years old with grade 2 or 3 varicoceles were created, including 88 who underwent varicocele repair and 36 controls. Testicular volume and pampiniform vein diameter were measured, and Doppler ultrasound was performed. RESULTS: After 12 months volume of the involved left testis increased to almost normal in treated boys (mean atrophy index 12.7% at surgery and 3% 12 months later). In controls the corresponding atrophy indexes were 10 and 9%, respectively. The relative increase in left testicular volume was 26% in the surgery group and 11% in controls. In the surgery group mean pampiniform vein diameter decreased from 2.8 preoperatively to 2 mm. postoperatively but there was no change in controls. CONCLUSIONS: Varicocele repair in adolescents with moderate and severe varicocele reversed testicular growth arrest and resulted in catch-up growth within 12 month of surgery.

Assessment of adolescent varicocele.

Varicocele is the most important male factor responsible for decreased fertility potential in married couples. From March through June 1994, 2,470 school boys aged 10-20 years were examined to establish the incidence of consecutive grades of varicocele and to develop a protocol for diagnosis and treatment of adolescents with varicocele. Grade 1 varicocele was found in 18%, grade 2 in 12%, and grade 3 in 5% of the population examined. An original protocol of ultrasonographic (US) examination (previously verified by angioscintigraphy) was introduced to assess boys with clinically diagnosed varicocele. The volume of each testis, testicular volume decrease (TVD), pampiniform vein diameter (PVD), and basal (BBF) and maximum blood flow (MBF) velocities were measured in 625 boys. In 74 cases a semen analysis was performed. The statistical analysis revealed that the presence of venous reflux and PVD correlated with the grade of varicocele. Decreases in testicular volume were highly dependent on the grade of varicocele, PVD, and BBF and MBF velocities. Analysis of the relationship between spermatic (boys over 17 years) and US findings revealed that the quality of spermatogenesis can be predicted by US examination in adolescents with varicocele. The authors recommend multiparametric US examination as a reliable, objective, and repeatable technique for establishing criteria for operative treatment in boys under 18 years of age with varicocele as well as for postoperative evaluation.

Semen analysis in young men with varicocele: preliminary study.

PURPOSE: Our aim was to determine whether the deleterious effect of varicocele on spermatogenesis, as reflected by semen analysis, occurs in boys as young as 17 to 19 years. Data analysis was done of semen variables of select boys attending randomly chosen schools. MATERIALS AND METHODS: A total of 36 healthy boys without a pathological condition detected by history, physical examination and scrotal ultrasound served as controls, and 38 with profound varicocele who were otherwise healthy served as an experimental group. All boys were followed as outpatients 2 times during the last year. We performed semen and clinical examinations, Doppler ultrasound assessment of venous reflux, and ultrasound measurement of testicular and pampiniform vein diameters. RESULTS: No significant differences were found in sperm concentration, volume, presence of spontaneous agglutination and pH between the 2 groups. There were significant differences in total and progressive sperm motility and vitality, which were lower in boys with varicocele, as were the number of normal sperm forms. There was a statistically and clinically significant linear negative relationship between sperm motility, and maximal and basal blood flow velocities as well as pampiniform vein diameter. CONCLUSIONS: Varicocele can affect spermatogenesis in boys as young as 17 to 19 years, as shown by the decrease in motility, vitality and number of normal forms of spermatozoons. The clinically significant correlations between semen analysis parameters and ultrasound findings allow the prediction of testicular function using ultrasound alone.

Biodegradation of trichloroethylene in continuous-recycle expanded-bed bioreactors.

Experimental bioreactors operated as recirculated closed systems were inoculated with bacterial cultures that utilized methane, propane, and tryptone-yeast extract as aerobic carbon and energy sources and degraded trichloroethylene (TCE). Up to 95% removal of TCE was observed after 5 days of incubation. Uninoculated bioreactors inhibited with 0.5% Formalin and 0.2% sodium azide retained greater than 95% of their TCE after 20 days. Each bioreactor consisted of an expanded-bed column through which the liquid phase was recirculated and a gas recharge column which allowed direct headspace sampling. Pulses of TCE (20 mg/liter) were added to bioreactors, and gas chromatography was used to monitor TCE, propane, methane, and carbon dioxide. Pulsed feeding of methane and propane with air resulted in 1 mol of TCE degraded per 55 mol of substrate utilized. Perturbation studies revealed that pH shifts from 7.2 to 7.5 decreased TCE degradation by 85%. The bioreactors recovered to baseline activities within 1 day after the pH returned to neutrality.

Narcotic analgesics and stereotyped behaviour in mice.

In this paper we have studied the effects of morphine, codeine, fentanyl, pentazocine, etorphine and fluphenazine (all drugs injected i.p.) on stereotyped behaviour induced by methylphenidate 60 mg/kg i.p., as well as induced by apomorphine 5 mg/kg s.c. in mice. It was found that all used analgesics and fluphenazine dose--dependently inhibited the intensity of methylphenidate--induced gnawing in mice. This effect of analgesics, but not that of fluphenazine was antagonized by naloxone (0.8 mg/kg i.p.) and nalorphine (10 mg/kg i.p.). Climbing behaviour induced by apomorphine was not reduced by narcotic analgesics, but fluphenazine inhibited this effect dose--dependently. These findings give the behavioural support that analgesics applied have antidopaminergic activity in mice.